Wednesday, August 12, 2009

Health Care and High Blood Pressure

Blood pressure is the pressure of the blood against the walls of the arteries, according to the American Heart Association (AHA). And, blood pressure results from two forces. One is created by the heart as it pumps blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow.
--The higher (systolic) number represents the pressure while the heart contracts to pump blood to the body.
--The lower (diastolic) number represents the pressure when the heart relaxes between beats.

According to the AHA, the systolic pressure is always stated first. For example: 118/76 (118 over 76); systolic = 118, diastolic = 76. Blood pressure below 120 over 80 mmHg (millimeters of mercury) is considered optimal for adults. A systolic pressure of 120 to 139 mmHg or a diastolic pressure of 80 to 89 mmHg is considered "prehypertension" and needs to be watched carefully. A blood pressure reading of 140 over 90 or higher is considered elevated (high). High blood pressure usually has no symptoms. In fact, many people have high blood pressure for years without knowing it. That's why it's called the "silent killer." Hypertension is the medical term for high blood pressure. It doesn't refer to being tense, nervous or hyperactive. You can be a calm, relaxed person and still have high blood pressure. A single elevated blood pressure reading doesn't mean you have high blood pressure, but it's a sign that further observation is required. Ask your doctor how often to check it or have it checked. Certain diseases, such as kidney disease, can cause high blood pressure. In 90 to 95 percent of cases, the cause of high blood pressure is unknown. The only way to find out if you have high blood pressure is to have your blood pressure checked. Your doctor or other qualified health professional should check your blood pressure at least once every two years, or more often if necessary. Optimal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg. However, unusually low readings should be evaluated to rule out medical causes.

One of the most dangerous aspects of hypertension, according to WebMD, is that you may not know that you have it. There are generally no symptoms of high blood pressure, so you usually don't feel it. In fact, nearly one-third of people who have hypertension don't know it. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. This is especially important if you have a close relative who has high blood pressure. If your blood pressure is extremely high, there may be certain symptoms to look out for, including:
--Severe headache
--Fatigue or confusion
--Vision problems
--Chest pain
--Difficulty breathing
--Irregular heartbeat
--Blood in the urine
--Pounding in your chest, neck, or ears
If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke. Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems.

According to WebMD, blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take. One high reading does not mean you have the diagnosis of high blood pressure. It is necessary to measure your blood pressure at different times while resting comfortably for at least five minutes to find out your typical value. To make the diagnosis of hypertension, at least three readings that are elevated are normally required. In addition to measuring your blood pressure, your doctor will ask about your medical history (whether you've had heart problems before), assess your risk factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about your family history (whether any members of your family have had high blood pressure or heart disease). Your doctor will also conduct a physical exam. As part of this exam, he or she may use a stethoscope to listen to your heart for any abnormal sounds and your arteries for a bruit, a whooshing or swishing sound that may indicate that the artery may be partially blocked. Your doctor may also check the pulses in your arm and ankle to determine if they are weak or even absent. If you're diagnosed with high blood pressure, your doctor may recommend other tests, such as:
1.) Electrocardiogram (EKG or ECG): A test that measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. The results are recorded on graph paper.
2.) Echocardiogram: This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made.

Changing your lifestyle can go a long way toward controlling high blood pressure, according to the Mayo Clinic. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems. The major types of medication used to control high blood pressure include:
--Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.
--Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.
--Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
--Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels.
--Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate.
--Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure.

Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders, according to the Mayo Clinic. To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error. If your blood pressure has remained stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. You may need to see a hypertension specialist if your primary care doctor isn't able to pinpoint a cause. It may also be that another condition you have that you may not be aware of, such as sleep apnea or kidney problems, is causing your high blood pressure. You may need to be more aggressive in following lifestyle recommendations.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Your doctor may also prescribe other medications, including a more potent or longer acting diuretic if you're not already taking one. Your doctor may also suggest nonthiazide diuretic drugs, such as spironolactone (Aldactone) or eplerenone (Inspra), which change the way your body absorbs sodium and excretes potassium by blocking the hormone aldosterone. People with resistant hypertension often have higher levels of aldosterone.

In addition, according to the Mayo Clinic, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take. If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't alter your treatment without your doctor's guidance.

According to the Mayo Clinic, lifestyle changes can help you control and prevent high blood pressure — even if you're taking blood pressure medication. Here's what you can do:
--Eat healthy foods, such as fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
--Decrease the salt in your diet.
--Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control.
--Limit alcohol.
--Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries.
--Manage stress, and get plenty of sleep if possible.
--Monitor your blood pressure at home.
--Practice relaxation or slow, deep breathing.

Maintaining a healthy blood pressure through proper medication and lifestyle choices will decrease the chances of major life threatening disease. Visit your primary care health provider to find out how your BP is doing, and listen to the doctor. Make sensible decisions about diet and exercise, and get away once in a while to relax. The best way to avoid problems with blood pressure issues is to use the tools available to manage your health.

Until next time. Let me know what you think.

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